Elsevier

The Lancet

Volume 367, Issue 9520, 29 April–5 May 2006, Pages 1448-1455
The Lancet

Public Health
The health migration crisis: the role of four Organisation for Economic Cooperation and Development countries

https://doi.org/10.1016/S0140-6736(06)68346-3Get rights and content

Summary

The crisis of human resources for health that is affecting low-income countries and especially sub-Saharan Africa has been attributed, at least in part, to increasing rates of migration of qualified health staff to high-income countries. We describe the conditions in four Organisation for Economic Cooperation and Development (OECD) health labour markets that have led to increasing rates of immigration. Popular explanations of these trends include ageing populations, growing incomes, and feminisation of the health workforce. Although these explanations form part of the larger picture, analysis of the forces operating in the four countries suggests that specific policy measures largely unrelated to these factors have driven growing demand for health staff. On this basis we argue that specific policy measures are equally capable of reversing these trends and avoiding the exploitation of low-income countries' scarce resources. These policies should seek to ensure local stability in health labour markets so that shortages of staff are not solved via the international brain drain.

Section snippets

Supply and demand for health workers in OECD countries

Statistics from WHO's Global human resources for health atlas25 suggest that the UK ranks among the least staffed of high-income countries, with 166 doctors and 497 nurses per 100 000 population (table 1)25, 26, 27, 28, 29—the second lowest doctor density (ahead of Turkey) and fourth lowest nurse density (ahead of Greece, Spain, and Turkey) of all OECD countries. However, this comparison seems to be misleading. Buchan27 reports that the official OECD figure for practising nurses counts only

Discussion and conclusions

The evidence from the four countries elucidates the balance between the effect of market forces and policy in determining the state of OECD countries' labour markets. Market forces clearly have an important role. As one example, the markets for doctors in Germany and for nurses in the USA demonstrate the effect of periods of pay depression in falling recruitment to training schools and retention of trained staff in the sector. To the extent that market forces hold sway, policies have to

Glossary

OECD
The organisation for Economic Cooperation and Development is a group of 30 member countries that share a commitment to democratic government and market economy.

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